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Section 23. Developing and Using Criteria and Processes to Set Priorities

Learn how to establish criteria for determining priorities in community improvement projects.

 

Image of a tiled floor with the quote: The role of leadership is to transform the complex situation into small pieces and prioritize them.

 
  • What do we mean by developing and using criteria and processes to set priorities?

  • Why develop and use criteria and processes to set priorities?

  • Who should be involved in developing and using criteria and processes to set priorities?

  • When should you develop and use criteria and processes to set priorities?

  • How do you develop and use criteria and processes to set priorities?

A community needs assessment is meant to bring to light issues in the community that need to be addressed. However, it’s unlikely that all those issues can be dealt with at the same time. You have to make choices about what’s most important and timely to deal with…but how do you decide what “important” means? Who gets to choose, and how? And once those choices have been made, how do you decide on the ways to address the issues you’ve identified as most urgent?

If you make those decisions well, your eventual action plan will effectively target the real needs of the community. In this section, we’ll discuss how you might go about choosing criteria for deciding which issues are most important to address and for deciding on the best strategies for addressing them. We’ll also look at how to develop processes for doing the choosing that are likely to result in good decisions and community support for your effort.

What do we mean by developing and using criteria and processes to set priorities?

First, let’s define some terms:

Criteria are standards for making a judgment. They provide guidelines for making decisions. They aren’t set in stone: the criteria you use for examining a particular set of issues may be different from those you us for another set, depending on the community you’re aiming at, the conditions that are in place at the time of the decision, the needs and concerns of the people making the decision, and other factors.

Priority is the order of importance in which one thing falls in relation to another. Like a set of criteria, priorities may change with changes in the community, or with changes in people’s concerns or knowledge.

When a community assessment has uncovered a number of issues – perhaps issues in different areas, such as health, economics, and racial attitudes – developing a set of criteria for deciding how important each one is to address is crucial to effective action. Without considering what its standards are beforehand, a planning group may be reduced to each member’s intuition or particular pet issue, and descend into argument and eventual chaos. That’s a worst-case scenario, but any level of confusion or aimless flailing can be avoided by establishing some agreed-upon criteria for determining what to tackle when.

There are two sets of criteria needed here. One will provide the guidelines for choosing one or more issues to work on. The second will help you determine what strategies and approaches are likely to be most effective in addressing the issues you’ve chosen. We’ll suggest some examples of each in the “how-to” part of the section.

The other necessary ingredient for cooking up a successful intervention or initiative is a decision-making process that will allow a planning group to choose criteria and approaches rationally and wisely.

In general, the ideal process is participatory and inclusive, involving all stakeholders – those affected by or concerned with the issues at hand – and the community at large. It’s best if it includes both people with technical expertise in the relevant fields – health, social policy, employment, etc. – and people grounded in the community. With that mix, criteria are likely to reflect best practices and good theory as well as real community needs, wishes, and norms.

To ensure community support, the fact that there is an inclusive process, developed at least in part by input from the participants in it, may be as important as the actual form of the process.

Why develop and use criteria and processes to set priorities?

  • It creates a structure that makes setting priorities more systematic and more likely to reflect the realities of the community.
  • It helps ensure the most important issues for your community are addressed. Using a set of criteria and a good decision-making process makes it much more probable that you’ll get the priorities right.
  • It provides an opportunity to involve the community in the effort and to get community buy-in. Any effort is far more likely to succeed if the community feels ownership of it and supports it.
  • An inclusive criteria-setting process makes sure you don’t miss anything that only stakeholders know. Community members, especially those most affected by issues, may have a clearer understanding of what’s important to the community and of which issues actually have the greatest impact on people’s lives.
  • Establishing criteria in a structured and inclusive way ensures that the process is an open one, and that any concerns are raised. It is essential to include those who are most affected by the problem.
  • The process of selecting criteria allows an opportunity to educate stakeholders who may not have had this kind of experience before about how to make informed, systematic decisions.

Who should be involved in developing and using criteria and processes to set priorities?

We’ve discussed involving all stakeholders…but just who are the stakeholders? There are several categories to be considered.

  • Those most affected by community issues and/or inequities. This category may include anyone, but most often involves groups with less power and influence.
    • People of low income
    • Diverse people and ethnicities, including immigrants
    • Youth
    • Seniors
    • People with disabilities
    • People living in substandard housing
    • Those most seriously at risk from or affected by particular health, economic, or social conditions
    • Those most seriously affected by negative environmental conditions
  • Organizations and institutions that serve or otherwise deal with those groups, including:
    • Health and human service providers, such as hospitals, welfare agencies, homeless shelters, and other community-based organizations
    • Faith communities
    • The business community, which needs access to a healthy and educated workforce
    • Schools and post-secondary institutions
    • Community coalitions
  • Those charged with carrying out or otherwise implementing proposed interventions, changes in policies or regulation, or preventative measures. These might include:
    • Staff of health and human service providers
    • School personnel
    • Public officials
  • Those whose jobs or lives will be affected by interventions, policy changes, or preventive measures. Some examples:
    • Police, who may have to respond to more calls
    • Landlords, who may be required to address substandard housing issues
    • Medical professionals, teachers, or others
  • Citizens concerned with the issue(s) at hand, including activists, academics, and professionals in fields related to the issues or populations of concern.
  • Local and other funders, such as United Way, state agencies, and foundations.

When should you develop and use criteria and processes to set priorities?

It is ideal to start creating a process to develop criteria for prioritizing issues as soon as you decide to conduct a community assessment. The process will go more smoothly if you’ve discussed and agreed upon criteria beforehand. Having an effective participatory decision-making process agreed to by community stakeholders as early in the process as possible is essential.

How do you develop and use criteria and processes to set priorities?

Assemble a participatory group representative of all stakeholders. The first step is to ensure participation and buy-in from the community by inviting stakeholders and other interested individuals and groups to constitute a planning group. Check with group members to make sure that there aren’t others who should be at the table. Make sure particularly that those most affected by community issues are represented, since their voices are the ones most often ignored. If only “leaders” – directors of organizations, CEOs, public officials, etc. – are part of the group, it’s likely that the community won’t feel ownership of the effort, and that the plan and intervention that result may not speak to the real needs of the people at whom they’re aimed.

Involving people who may not be used to being included in planning and implementing efforts can be time-consuming. They may need training and support before they’re comfortable speaking up in meetings and realizing that they bring a valuable perspective. They may also feel uncomfortable about not knowing the “rules” that pertain in meetings, and thus not participate for fear of getting it wrong. With support, however, these folks can become the most valuable members of a planning group because of their knowledge of the populations they belong to. The time spent to orient and support them is more than worth it.

For this reason, as well as for the smooth running of the group, it would be wise to find a facilitator who can relate to people of diverse backgrounds and who has experience with groups and with planning processes. A skilled facilitator’s presence and expertise at guiding decision-making can render the group’s tasks both shorter and more effective.

Identify the interests of various stakeholder groups in relation to the process of setting priorities and using them to plan the implementation of an intervention or initiative. Depending on their perspective – as health or human service providers, as part of the population affected by community issues, as public officials, etc. – their interests might have to do with:

  • The openness and fairness of the process
  • The use of a democratic process
  • The creation of a forum where all voices can be heard
  • The feasibility of the plan and of affecting the targeted issues
  • The costs of the plan
  • The use of proven practices
  • Whether individual or organizational certification can be obtained or enhanced by taking part in the effort
  • The involvement of particular organizations or groups
  • The need for funding or matching funds
  • The necessity of a plan that will address stakeholders’ specific areas of concern
  • The necessity of addressing social determinants
  • The importance of being respectful of all and of their concerns, even when there’s disagreement

Establish clear criteria for setting priorities for community issues to be addressed. Through discussion, brainstorming, or another method of generating ideas, the group should be able to agree on a number of criteria. Some possible examples, depending on the issues involved and the needs of the community:

  • The seriousness of the issue – the death of a homeless person due to extreme temperatures, child hunger, etc.
  • The frequency of the issue – rare, affecting a majority of the community, confined to a single area, targeting a single population group.
  • The cost of the issue to the community – in dollars, in time spent dealing with it, in social costs (people afraid to leave their houses after dark, lost productivity from illness, etc.)
  • The feasibility of affecting the issue.
  • The resources needed to address the issue adequately.
  • The community’s perception of the issue’s importance.
  • The readiness of the community to recognize and address the issue.
  • The long-term impact of the issue.
  • The long-term benefit of your effort.
  • The fit of addressing the issue with your organization’s vision and mission.
  • The possibility of an intervention causing unintended negative consequences.

Establish a process for engaging stakeholders and the broader community in setting priorities for issues to address. Once you have a list of criteria, you’ll have to decide how to apply them in determining the priority order of the issues you’ve identified in your community assessment. Creating a process for doing so will make for smoother and more effective decision-making.

  • Review the criteria and ensure that everyone understands and continues to agree on them.
  • Discuss the issues in question, again making sure that everyone understands them and their implications. Some issues may in fact be eliminated as potential targets as a result of this discussion.
  • For each issue, discuss whether an issue is strategic or not – i.e., whether addressing it is feasible, whether it has larger implications, whether it ties into other efforts, whether addressing it will bring other benefits, etc.
  • Individually or in small groups, rate each issue in terms of its importance and the feasibility of affecting it.
  • Discuss the ratings as a group, examining whether some issues can be consolidated – i.e., considered as a single issue, or as two or more issues that could be addressed by a single intervention.
  • Using the criteria the group agreed upon, rank order the issues and select the highest three to five.

There are a number of ways to do this. One is, after the discussions described above, to simply list the issues and have the group vote to identify the top choices. This can be done by a show of hands, or by asking people to write down their selections and tabulating the results. A common method is to give each person paper dots – often color-coded for first choice, second choice, etc. – to stick on the list of issues. The number and colors of the dots then serve to record the vote and to identify the issues group members thought most important.

There are a number of more formal prioritizing methods as well. See Tool #1 for descriptions of five of the most common.

  • From the top choices, vote on the issue or issues that you’ll address.

Establish criteria for selecting an approach to address each of your priority issues. Possible criteria might include:

  • Cost-benefit
  • Feasibility of carrying out the approach
  • The likelihood that the approach will resolve the issue
  • The fit of the approach with the effort’s/organization’s/institution’s vision and mission
  • The fit of the approach with community standards
  • The compatibility of the approach with efforts already ongoing
  • Whether the approach is a best or promising practice tried successfully elsewhere
  • The availability of people with the expertise to carry out the approach or to train others to do so
  • The availability of community assets that can be used in this approach
  • The availability of adequate resources to be effective
  • The possibility of collaboration or shared workload

Establish a process for selecting approaches. Once again, you have choices to make. The basic process here is likely to be very similar to the one you used to choose the issue(s) to work on.

  • Review the criteria for selecting approaches that you agreed on, and make sure that everyone understands them clearly and still agrees.
  • Discuss the possible approaches in terms of their history of success, their fit with the community context and standards, their appropriateness in relation to your mission, etc.
  • Individually or in small groups, rate the possibilities by how well they’re likely to work and how feasible they would be to implement.
  • Discuss the ratings as a group, considering whether one or more approaches might be consolidated or combined.
  • Rank order and select priorities, using the same method as that used for prioritizing issues.
  • From the top choices, vote on which approach(es) to use.

Finalize your choices. Make sure you’ve considered such factors as what else is going on in the community, where your resources are likely to come from, who might best implement the effort, and whether people will have to be hired for the purpose.

Make sure as well that your final decisions are truly agreed-upon and participatory. As we’ve discussed, there are likely to be people in the group who have little experience with this kind of process, and who may be reluctant to speak up, especially if they disagree with the majority. Yet they may have information or emotional reactions that are extremely important because of their grounding in the community. It’s essential that the planning group’s facilitator makes sure to draw them out and that the group supports them in speaking out, regardless of the substance of their comments.

If you are working with more than one issue, try to identify factors that relate to all of them. You may find that, rather than approaching issues directly, you can be more effective by directing efforts toward social determinants or root causes that affect issues “upstream.” Looking at health issues, for example, a focus on environmental changes to enhance access to healthy food for all can help reduce cardiovascular disease and health disparities.

Look for ways in which your issue and approach might mesh with other community efforts. Look for overlap or ways to share work or collaborate with other efforts. If parts of your approach or initiatives aimed at your target are already in place and successful, make sure you’re working together rather than at cross purposes, and that you’re not trying to reinvent the wheel. The more collaborative your approach, the more likely that everyone in the community will be positively affected.

Be prepared to monitor your effort and change priorities as conditions change. Communities continue to develop and change, and your effort should change as well if it’s no longer addressing the needs that are most urgent and most important to community members. You can use your criteria and your processes whenever you think you might need to change direction.

In Summary

Establishing criteria – standards – and processes for deciding on what are the most important issues to tackle and how to tackle them makes those decisions much easier. It also allows for a participatory planning process from the very beginning of an effort, thus helping to obtain community support and ownership of the plan for addressing issues. Furthermore, it supplies a tool that the community can use both to adjust the implementation of the effort in response to changes in conditions in the community or in future endeavors.

Contributor 
Phil Rabinowitz

Online Resources

The Guide to Prioritization Techniques is from the National Association of County & City Health Officials and provides five widely used options for prioritization, including guidance on which technique best fits the needs of your agency, step-by-step instructions for implementation, and practical examples.

Health District of Northern Larimer County, Fort Collins, Colorado.

Priorities, Impact, and Indicators. Information on priority setting from THRIVE, a tool of the Prevention Institute to help communities address health disparities and inequities.

BMC Health Services Research. Setting priorities in health care organizations: criteria, processes, and parameters of success. Jennifer L. Gibson, Douglas K. Martin, Peter A. Singer. Biomed Central, Ltd, 2004.

Strategic Issues - Overview, also from the National Association of County & City Health Officials, offers five steps for how to identify stragetgic issues.

Print Resources

Fawcett, S., Holt C., & Schultz J., Some Recommended Practice Areas for Enhancing Community Health ImprovementWork Group for Community Health and Development / World Health Organization Collaborating Centre, University of Kansas.